Cushing's syndrome: Everything you need to know
Cushing's syndrome is a rare but serious condition caused by prolonged exposure to high levels of cortisol, a hormone produced by the adrenal glands. Cortisol plays an essential role in various bodily functions, including regulating metabolism, blood sugar levels, and the body's response to stress. However, when cortisol levels are abnormally high for extended periods, it can lead to a range of symptoms and health complications.
The objective of this blog is to provide a comprehensive overview of Cushing's syndrome, including its causes, symptoms, and available treatment options, to help readers better understand and manage the condition effectively.
What is Cushing's Syndrome?
Cushing’s syndrome, also known as Hypercortisolism, is a condition in which the body is exposed to elevated levels of cortisol over a prolonged period. Cortisol is an essential hormone produced by the adrenal glands, playing a key role in the body’s stress response, metabolism, and immune function.
However, when cortisol levels become excessively high, it can lead to a variety of physical changes, such as weight gain, muscle weakness, high blood pressure, and more.
The Cushing syndrome definition refers to a set of symptoms resulting from chronic exposure to excess cortisol. In contrast, Cushing's disease is a specific type of Cushing's syndrome caused by a tumour in the pituitary gland that stimulates the adrenal glands to produce too much cortisol.
Understanding Cushing's syndrome physiology is crucial in comprehending the impact of high cortisol levels on the body. Cortisol affects many systems, including the metabolism of fats, proteins, and carbohydrates, leading to the development of common symptoms like abdominal fat accumulation, thinning skin, and increased susceptibility to infections.
A 2024 study found that Cushing's disease, the most common cause of endogenous Cushing's syndrome, accounts for 60-80% of cases. The incidence is estimated to be between 0.7 and 2.4 per million per year, with a higher prevalence in women aged 25 to 40.
What is the difference between Cushing Syndrome vs Cushing’s Disease?
It’s important to distinguish between Cushing's syndrome and Cushing's disease. While both conditions involve excessive cortisol, Cushing’s disease is a more specific diagnosis, where the underlying cause is a pituitary adenoma (a benign tumour of the pituitary gland).
In contrast, Cushing's syndrome can be caused by other factors, such as long-term use of corticosteroid medications or tumours in the adrenal glands.
Dr. Pranav A Ghody, Endocrinologist, Wockhardt Hospital, Mumbai Central said, “Cortisol has effects on almost every organ in our body; it is essential for maintaining blood pressure, blood sugar, energy metabolism and inflammation control. This hormone is often called the stress hormone as the adrenal glands produce more cortisol to regulate the stress response. Excessive cortisol levels over a period cause a complex disorder called Cushing’s syndrome”
What are the causes of Cushing's Syndrome?
Several factors can lead to the development of Cushing’s syndrome, ranging from medication use to more complex physiological issues. Some of the common Cushing syndrome causes include:
- Corticosteroid Medications: Long-term use of oral or injected steroids, such as prednisone, is one of the most common causes of Cushing's syndrome. These medications mimic cortisol in the body and, when used over time, can lead to hypercortisolism.
- Pituitary tumours (Cushing’s Disease): A benign tumour in the pituitary gland can lead to the overproduction of adrenocorticotropic hormone (ACTH), which in turn stimulates the adrenal glands to produce excessive cortisol. This is referred to as Cushing’s disease.
- Adrenal tumours: Tumours in the adrenal glands can also cause overproduction of cortisol, leading to hypercortisolism.
- Ectopic ACTH Syndrome: In rare cases, tumours in other parts of the body (such as the lungs) may produce ACTH, triggering excessive cortisol production.
- Genetic Factors: Some rare genetic conditions can predispose individuals to developing Cushing's syndrome or other related disorders.
What are the signs and symptoms of Cushing's Syndrome?
The symptoms of Cushing's syndrome vary from person to person but generally result from prolonged exposure to high cortisol levels. Common Cushing syndrome symptoms include:
- Weight Gain: One of the hallmark symptoms of Cushing syndrome is the accumulation of fat around the face, upper back, and abdomen, leading to a characteristic "moon face" and "buffalo hump."
- Skin Changes: Individuals with Cushing's syndrome may experience thinning of the skin, easy bruising, and the development of purple or pink stretch marks (striae), especially on the abdomen, thighs, and arms.
- Muscle Weakness: The excess cortisol leads to muscle breakdown, causing weakness, particularly in the arms and legs.
- High Blood Pressure: Cortisol can increase blood pressure, and many individuals with Cushing's syndrome also have hypertension.
- Mood Changes: Elevated cortisol levels can cause mood swings, irritability, anxiety, and even depression.
- Irregular Menstrual Cycles: Women with Cushing's syndrome may experience irregular periods or even amenorrhea (absence of menstruation).
- Fatigue: Chronic fatigue and a general feeling of being unwell are common among those suffering from Cushing's syndrome.
In more severe cases, Cushing's syndrome can lead to diabetes, osteoporosis, and even an increased risk of infections.
What are the diagnosis for Cushing's Syndrome?
Cushing's Syndrome Diagnosis can be challenging due to the wide variety of symptoms that overlap with other medical conditions. A doctor may start by performing several tests, including:
- 24-Hour Urinary Free Cortisol Test: This test measures the amount of cortisol excreted in the urine over a 24-hour period.
- Blood and Saliva Tests: These tests measure cortisol levels at various times of the day. Normally, cortisol levels should be lower in the evening than in the morning.
- Dexamethasone Suppression Test: This test involves taking a dose of dexamethasone (a synthetic steroid) and measuring cortisol levels afterward. In people with Cushing's syndrome, the cortisol levels typically do not decrease as they would in a healthy individual.
- Imaging Tests: CT scans or MRIs may be used to detect tumours in the pituitary or adrenal glands.
What are the best treatments for Cushing's syndrome?
Treatment for Cushing's syndrome depends on the underlying cause of the condition. Cushing's syndrome treatment options include the following:
1. Surgical Removal of tumours: If a tumour is responsible for excessive cortisol production, surgical removal is often the first line of treatment.
2. Radiation Therapy: For pituitary tumours that cannot be removed surgically, radiation therapy may be recommended.
3. Medications: In some cases, medications may be prescribed to block cortisol production or its effects on the body. These include drugs like ketoconazole, metyrapone, or mitotane.
4. Corticosteroid Reduction: If Cushing syndrome is caused by long-term use of corticosteroid medications, the doctor may gradually taper off the steroids, but only under careful medical supervision.
5. Lifestyle and Diet Changes: A Cushing syndrome diet that focuses on managing weight, controlling blood pressure, and reducing the risk of diabetes can be essential for recovery. A healthy diet and regular exercise can help manage many symptoms.
What foods are good for Cushing's syndrome?
A balanced Cushing's syndrome diet can significantly help manage symptoms by regulating cortisol levels, blood pressure, and weight. Whether dealing with mild Cushing's syndrome or the more severe form, proper nutrition is essential for recovery.
Below is a sample diet chart for Cushing's syndrome, featuring Indian foods that can aid in managing this condition. Here’s a sample diet chart for Cushing’s syndrome:
Time | Food to prefer | Reason |
| Early Morning | Warm water with lemon and a pinch of turmeric | Helps detoxify the body and reduce inflammation. |
| Breakfast | Oats porridge with chia seeds, nuts (almonds, walnuts), and fresh fruits (like apple or papaya) | High in fiber, antioxidants, and healthy fats, which are good for weight management and metabolism. |
| Mid-Morning Snack | Fresh coconut water and a small bowl of mixed fruits (like berries, pomegranate) | Hydrates and replenishes electrolytes. |
| Lunch | Brown rice with dal (lentils), vegetable curry (like spinach, cauliflower, and carrots), and roti (whole wheat) | Protein-rich dal supports muscle health, and veggies provide essential vitamins. |
| Afternoon Snack | Buttermilk (chaas) with roasted flax seeds | Good for digestion and provides probiotics. |
| Evening Snack | Baked or roasted chickpeas (chana) or a small serving of mixed nuts | High in protein and fibre and supports blood sugar control and muscle recovery. |
| Dinner | Grilled or steamed fish (like mackerel or tilapia) or tofu with steamed vegetables (like broccoli or zucchini) | Lean protein helps in muscle repair and stabilises cortisol levels. |
| Post-Dinner | A warm cup of herbal tea (like chamomile or peppermint) | Helps reduce stress and promotes better sleep. |
What foods should Cushing patients avoid?
- High-Sodium Foods: Processed foods, canned foods, and salty snacks can exacerbate high blood pressure.
- Refined Sugars: Sweets, sugary beverages, and pastries can lead to blood sugar spikes, worsening the condition.
- Excessive Caffeine: Limit coffee or caffeinated beverages, as they can increase cortisol production.
Cushing Syndrome Before and After Dietary Changes
Before adopting a healthier diet, individuals with Cushing's syndrome may experience significant weight gain, fatigue, and high blood pressure. After following a well-structured Cushing syndrome diet, including more whole foods, lean proteins, and fiber-rich vegetables, many people notice improvements in weight management, reduced bloating, and a reduction in blood pressure.
Frequently Asked Questions
Q1. What is the difference between Cushing syndrome vs Addison's disease?
Cushing's syndrome is caused by high levels of cortisol in the body, often due to overproduction or steroid use, leading to symptoms like weight gain and high blood pressure. In contrast, Addison's disease results from insufficient cortisol production, causing symptoms like fatigue, weight loss, and low blood pressure.
Q2. What is the difference between Primary vs secondary hypercortisolism?
Primary hypercortisolism, also known as Cushing's disease, occurs when the adrenal glands produce excess cortisol, usually due to a tumour. Secondary hypercortisolism is caused by excessive production of ACTH (adrenocorticotropic hormone) from the pituitary gland, which stimulates the adrenal glands to produce more cortisol.
Q3. What are the three symptoms of Cushing's syndrome?
Three symptoms of Cushing's syndrome include weight gain, particularly around the abdomen and face (moon face), high blood pressure, and muscle weakness.
Q4. Can corticosteroids cause Cushing's syndrome?
Yes, corticosteroids can cause Cushing's syndrome when taken in high doses or for extended periods, leading to increased cortisol levels in the body.
Q5. Are you born with Cushing's syndrome?
Cushing's syndrome is typically not something you're born with; it usually develops due to factors like tumours or prolonged steroid use. However, some rare genetic conditions can cause it. Hypercortisolemia vs hypercortisolism refers to the same condition—both terms describe the excessive presence of cortisol in the body, but hypercortisolemia is a broader term that may encompass other causes beyond Cushing's syndrome.
Wrapping up
Cushing syndrome is an endocrine disorder caused by prolonged high cortisol levels resulting from factors like medication use or pituitary tumours. Early symptom recognition, accurate diagnosis, and appropriate treatment are crucial for effective management.
If you suspect Cushing's syndrome, consult a healthcare provider to explore causes and treatment options, helping you manage the condition and improve your quality of life.
Also, read our other related articles:
1. Top 10 Triggers of Mental Stress You Can’t Ignore
2. What’s Really Weakening Your Immune System?
References
1. Chaudhry HS, Singh G. Cushing Syndrome. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470218/
2. Lodish MB, Keil MF, Stratakis CA. Cushing's Syndrome in Pediatrics: An Update. Endocrinol Metab Clin North Am. https://pubmed.ncbi.nlm.nih.gov/29754644/
3. Osswald A, Deutschbein T, Berr CM, Plomer E, Mickisch A, Ritzel K, Schopohl J, Beuschlein F, Fassnacht M, Hahner S, Reincke M. Surviving ectopic Cushing's syndrome: quality of life, cardiovascular and metabolic outcomes in comparison to Cushing's disease during long-term follow-up. Eur J Endocrinol. https://pubmed.ncbi.nlm.nih.gov/29875286/
